TUGAS INDIVIDU

DELEGATION IN NURSING PRACTICE

Disusun untuk memenuhi tugas pada Mata Kuliah Etika dan Hukum Kesehatan
Dosen Pengampu Mata Kuliah Hudijono, SKep., MH. Kes

Disusun Oleh :
Nama

: Ni Wayan Rahayu Ningtyas

NIM

: P1337420815007

Jurusan

: Magister Terapan Kesehatan Keperawatan

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

MAGISTER TERAPAN KESEHATAN PRODI KEPERAWATAN
PROGRAM PASCA SARJANA POLTEKKES KEMENKES SEMARANG
TAHUN 2015

DELEGATION IN NURSING PRACTICE

A. Definition
Delegation is the transfer of responsibility for the performance of task from one

individual to another while retaining accountability for outcome (Kelly,2011).

Delegation is transferring to a competent individual the authority to perform a

selected nursing task in a selected situation (Hansten, 2009).

In 2006, the ANA and the NCSBN collaborated in their Joint Statement on delegation
and altered the definition os assignment to describe the distribution of work that each

staff member is responsible for during a given shift or work period (LaCharity, 2013).
Define of delegation of nursing as the process for a nurse to direct another person to
perform nursing tasks and activities (Huber. L. Diane).

B. Principle of delegation
1. Nurse must have knowledge of the nurse practice act in the state where they are
licensed. Each states nurse practice act defines the RN scope of practice and
discusses appropriate delegation. A second resource in delegation is the employing
organizations policy and procedure manual. Employers must have job descriptions
for each job class that outline the responsibilities and limitations of each position.
2. The RN cannot delegate assessment, planning, evaluation, or accountability for the
assigned task. This means that even though the task has been assigned, the RN is still
responsible for following up with the delegate to ensure that the task has been
complete. If the delegate does not carry out the task in a satisfactory manner, the RN
is responsible for seeing that it is complete.
3. The person whom the assignment was delegated cannot delegated that assignment to
someone else. If the person carry out the assignment, the individual needs to notify
the delegating RN so that the task may be reassigned or completed by the RN.
C. The Five Right Delegation
The NCSBN developed the five right of delegation in 1995. Eleven years later, in 2006,
The American Nurses Association (ANA) and The NCSBN Joint Statement on delegation
clarified the five right of delegation. These five rights used by the nurse who delegates
patient care.

The right task

FIVE RIGHT OF DELEGATION

Has the organization established policies and
standars consistent with the state nurse practice

act; federal, states and local regulations and

guidelines for practice; nursing professional
standards; and the ANA Code of Ethics (ANA,

Under the Right Circum

2005)?
Can this task be delegated to any staff?
Are patient and community needs met?
Are the setting and available resources

conducive to safe care?

Does staff understand how to do the task

safely?
Does the job description; education and
competency of the RN, LPN/LVN and NAP

To the right person

macth the task?

Does staff do delegated tasks correctly?
Does staff have the resources, equipment and

supervision needed to be work safely?

Is the right person delegated the right task to the
right person to be performed on the right

With

the

right

patient?
Is the patient stable with predictable outcomes?
Is it legally acceptable to the delegate to this

person?
Do personal have documented knowledge, skil,

direction

and competency to perform the task?

Does RN communicate the task clearly with

directions and communication

directions, specific steps of the task, limits and

expected outcomes?
Are times for feedback specified?
Is staff understanding of the task clarified?
Can staff say I dont know how todo this and I

Under the right supervision and

need help without jeopardizing their job?

Is there appropriate monitoring, intervention,

evaluation

evaluation, and feedback as needed?

Does the RN answer staff questions and

problem solve as needed?

Does the staff report task completion and

patient response to the RN?

Does the RN provide follow up teaching and

guidance to staff as appropriate?

Are problems, particulary any sentinel events,
clarified or reported via the chain of command
and as needed to the state board of nursing and
accrediting agency?

D. Law and Regulations

Laws and regulations concerning delegation to nurses contained in UU No. 38 of 2014
about Nursing.
1. The implementation of tasks based on the delegation of authority as referred to in
Article 29 paragraph (1) letter e may only be given in writing by the medical
personnel to the nurse to do something medical action and evaluate its
implementation.
2. Delegation of authority as referred to in paragraph (1) can be made discretionary or
mandates. Delegation of authority is discretionary to do something medical
procedures provided by medical personnel to nurse accompanied by delegation of
responsibility.
3. Delegation of authority is discretionary as referred to in paragraph (3) may only be
granted to professional nurse or trained vocational nurses who have the necessary
competence.
4. Delegation of authority by the mandate given by the medical personnel to the nurse to
do something under the supervision of medical action.
5. The responsibility of a medical procedure on devolution mandate referred to in
paragraph (5) is in the giver devolution.
6. In performing its duties under the delegation of authority as referred to in paragraph
(1), Nurse authorities:
a. Perform medical procedures in accordance with their competence on the
delegation of authority discretionary medical personnel
b. Perform medical procedures under the supervision of delegated mandate; and
c. Providing health services in accordance with government programs. And in article
37 in point f containing Implement actions delegation of authority from other
health personnel in accordance with the competence of Nurses.
E. Case
A 12-year-old child suffering from paralysis since 8 years ago. The incident began when a
fall victim to alleged malpractice committed by nurses. B brought his parents go to the
clinic of the doctor F which has just one year opened a clinic. A child who was then 4
years old, suffered bumps gland for quail eggs in the back. Tumor already exists since A

is still a baby. Based on the results of medical examination F suggested that the lump was
immediately operated on. Then the old man agreed to do the surgery on September 12,
2015. Dr. F said that the surgery time was counterparts surgeon who was in fact a nurse.
At the time of the operation the doctor F does not help. A month after the operation is
completed the patient's body becomes limp and stiff, even his legs paralyzed. Eventually
the family take a stand for F and his physicians report to the police.
F. Analysis of laws and regulations according the case
Based on the rule of law in Indonesia in Law No. 38 of 2014 concerning the nursing nurse
break the rules:
1. Article 32 paragraph 2 explained that the delegation of authority to the nurses of
medical action can be done in delegation and mandate. In paragraph 5 the delegation
of authority by the mandate given by the medical staff to nurses to do something
under the supervision of medical action. But the reality is F doctor is only delegate
this task without any control measures to nurses.
2. Article 36 explains that the nurses carry out nursing practice, have the right to refuse
the client's wishes or others who is contrary to the code of ethics, standards of service,
profession and statutory of law. In accordance with the code of ethics of nursing
(PPNI, 2005), nurses are also entitled to refuse independently operating actions that
are contrary to the code of ethics of nursing among nurse and peers. Nurses must act
to protect clients from health professionals who provide health services incompetent,
unethical and illegal.
3. Article 37 point (f) explains that the nurses in performing nursing practice obliged to
implement the delegation of authority from other health personnel in accordance with
the competence of nurses. Nursing services should be based on the standards of
competence of nurses in Indonesia, a series of actions based on legal and ethical
aspects of culturally sensitive to meet the needs of clients. These activities include
procedural activities, for taking clinical decisions that require critical analysis and
advocacy activities to show caring behavior. Based on the above cases, the nurse does
not perform nursing services in accordance competence professional practice, ethical,
legal and culturally sensitive.

DAFTAR PUSTAKA

Huber. L. Diane. 2014. Leadership Nursing Management. Elsevier Saunders. China

Hansten I. Ruth and Marilynn Jackson. 2009. Clinical Delegation Skills. Jones and Bartlett
Publishers.USA
Kelly, Patricia and Maureen T Marthaler. 2011. Nursing Delegation,Setting Priorities and
Making Patient Care Assignments. Cengage Learning. Canada.
LaCharity, A. Linda. 2013. Prioritization, Delegation and Assignment.Deborah L. Vogel
Publisher. USA.